Fellow Maggie Cochran's FIMRC Experience

Maggie Cochran is Project Huancayo's wonderful FIMRC Fellow. She currently took a brief hiatus from her posting in Peru to travel to FIMRC's Project Alajuelita in Costa Rica and Project Las Delicias in El Salvador. Below, Maggie recounts her experience and compares and contrasts our different Project Sites from the perspective of a FIMRC Fellow! Enjoy!

This past month, I have had the pleasure of visiting FIMRC’s Project Sites in both El Salvador and Costa Rica.  Each site that I have seen has its own distinct personality—its own staff, schedule, patient population, day-to-day feel.  But then again, each site strives for the same, united goal: to improve pediatric and maternal health in the developing world via health education, enhanced access to primary care services, and community empowerment.  I can honestly say that I am proud to be a part of the FIMRC community, and would be happy to serve at any one of its diverse site locations.

Indeed, the focus of FIMRC’s El Salvador clinic is women.  This is not to say the healthcare provided for children and the education classes targeted at teens are not incredibly important elements of the Las Delicias clinic—but the Micro-Health Insurance Program has made wonderful progress in encouraging and empowering women to take control of their own health.  This insurance program offers benefits to women who engage in positive health behaviors.  For example, if a woman attends the weekly health education sessions, and takes the necessary steps to purify her water, separate her garbage from her household, keep her bathrooms clean, etc., then she can receive health credits that may later be exchanged for household items that further encourage healthy living (i.e. mosquito nets, concrete floors, etc.).  The vast majority of these women are very serious about the program, writing notes during education classes and taking pride in the cleanliness of their homes.  I felt honored to have witnessed this program in action, and believe its original and effective structure could—and should—be applied to other underserved communities around the world.

FIMRC’s clinic in Alajuelita, Costa Rica, is much more urban. The location serves an extremely poor population—including Nicaraguan refugees—who live in the nearby slums.  Duties in the Alajuelita clinic involve taking patient vitals every morning, shadowing Doctor Reinhart Stedem, observing the psychologist Tatiana Blanco, or working in the pharmacy to fill a variety of prescriptions.  Although the clinic technically serves only children, mothers and fathers are regularly treated as well, as the health of a child is often directly affected by the health of his/her caretakers.  Members of the Alajuelita community often suffer from parasites, bronchial infections, and, most commonly, malnutrition.  Many of these families are eating a diet of rice and tortillas, hardly anything else.  Starch is cheap, and many community members lack any sort of nutritional education—thus, a considerable number suffer from diabetes, chronic diarrhea, and other distressing side effects of not eating fruits, vegetables, and healthy proteins.  Much of Doctor Stedem’s work involves offering nutritional advice and healthy living advice to these families: he is a family doctor, a nutritionist, a preventative health care educator, and a psychologist, all rolled into one.

So how did my experiences in El Salvador and Costa Rica compare to my situation here in Perú?  What are the similarities, what are the differences?  Indeed, the most obvious difference is that El Salvador and Costa Rica have their own, private FIMRC clinics, while FIMRC works within the public hospital system here in Huancayo, Perú.  Thus, my work experience here in Peru is incredibly different: I spend my days on rounds with all different types of doctors—primary care doctors, pediatricians, obstetricians, neonatologists, neurosurgeons, the list goes on. Needless to say, I love my work here.  It may be a bit more impersonal than working in a one-doctor clinic, but the residents have grown to become some of my best friends here in Huancayo and I love the variety- I never know what’s coming next.  Here, I have learned how to be flexible, how to handle plans changing, schedules changing, everything constantly in flux.  I have learned how not to be overwhelmed by chaos, but instead energized by it: the unpredictability of things now keeps me engaged, excited for every new day and every new set of conditions.  Finding method and efficacy amid all of this has become my new passion.

Although I could continue to delineate the differences between each FIMRC site, I prefer to mention one beautiful, inspiring similarity: across all three sites, women were eager to learn about their own health and excited to take control of their own bodies, minds, and wellbeing through involvement in their own healthcare.  Unfortunately, much of Latin America is marked by machismo: a culture of aggressive manliness in which men feel they have the right to dominate women, the right to abuse women physically, sexually, and emotionally.  By providing education and access to healthcare to women and their children, FIMRC empowers women to take control of this aspect of their lives, even if there may be other areas in which they feel helpless.  In El Salvador, women are empowered through the Micro-Health Insurance Program to educate themselves, and take steps to construct a healthy living situation for themselves and their families. In Costa Rica, women are empowered to engage in their healthcare through physical and mental health services offered by the clinic, and health education sessions offered at the local soup clinic. Here in Huancayo, I have seen firsthand how psychological counseling and mental health education for the female caretakers in a local orphanage can empower these women to take care of their own mental health, so that they may positively affect the mental health of the children they care for.

Of course, I cannot close this essay without mentioning FIMRC’s incredibly impressive staff—from El Salvador, to Costa Rica, to Perú.  I learned an extraordinary amount during my travels, just by talking to the warm, intelligent team members I met at each site.  In El Salvador, field operations manager Marloes Nijboer and I had long, profound talks about international development, and what it means to make development sustainable, while activities coordinator Italo Rogel had a lot to say about the culture and misconceptions of his country.  In Costa Rica, Doctor Stedem and health program coordinator Camilo Ocampo spoke thoughtfully about the nuances of Costa Rican health insurance, and, over long car rides, driver Alvaro Gonzalez opened up about machismo and its effects on family structure in Costa Rica.  And last, but not least, I have my wonderful coordinator here in Perú—Natalia Riviera—from whom I’ve learned about healthcare, international development, Peruvian and Latin American culture, stress management, and so on.  If I have any guidance for those traveling with FIMRC or otherwise, my advice is to talk to people.  Talk to staff, talk to taxi drivers, talk to waiters, talk to anyone and everyone you meet.  I think you’ll find people are more than willing to open up about their culture and their day-to-day lives—and I know that I learned more through my conversations with people than I ever could have reading a travel guide.

Indeed, I have been lucky to travel with FIMRC, to have had the unique opportunity to compare several of its diverse sites side-by-side.  Via a variety of distinct means, each site has managed to work towards the FIMRC mission: to provide quality healthcare to children and mothers in the developing world.  I am proud to work for FIMRC, and am excited to take what I have learned from my journeys abroad and apply each lesson here in Huancayo and beyond.  Gracias por compartir tu tiempo conmigo, and let the adventures continue!

For more information about becoming a FIMRC Global Health Volunteer, Ambassador, or Fellow, visit our website at http://fimrc.org/get-involved.html